Like many of the patients I take care of with malignant brain tumors, Samantha Rice is an affable person, and perhaps even a bit gregarious. It is actually rare that I confront a patient with this type of diagnosis or any type of cancer for that matter that is a mean-spirited person. And in most cases it is not that this diagnosis changes their hearts for the better, it just seems most of them are just nice people to begin with. In fact, my former partner, Kevin and I used to say (years ago), ‘It’s never the a________ that get cancer… the ones that do are the nicest people you will ever meet’. Today, because my faith has become a more prominent part of my life, I no longer say it quite that way, but the apparent reality of it still makes an impression on me.
Samantha had begun to experience the sensation that her head was in a cloud and at times she would feel confused, forgetting what she was about to say or do. She then became unsteady when she walked, but it wasn’t until she noticed her left arm wasn’t working well and that she began to slur her words that she went to the doctor. Immediately he sent her to the emergency room where a CT scan was done which revealed she had a large brain tumor in the frontal lobe on the right, likely a malignant astrocytoma.
In general, if you had to have this kind of a brain tumor, the right frontal lobe is one of the places where you would want it to be. The motor strip is behind you and the speech area is on the left side so surgery is relatively safe and the possibility of removing most of it without causing a neurological deficit is good to excellent. That is unless the MRI shows that the tumor is clearly extending across the corpus callosum, or the pathways which connect the two halves of the brain.
Another exception may be if the tumor extends down to the wall of the ventricle, which I have previously described as the cerebrospinal fluid containing cavities within the brain. In this case there is the possibility that cells could spread to another area of the brain if during the course of removal the ventricle is opened allowing the tumor to enter the cerebrospinal fluid pathway. This was how Samantha’s tumor appeared, growing all the way to the wall of the frontal horn of the lateral ventricle.
When I met Samantha she impressed me as a very positive and upbeat person. Though she didn’t seem to be a religious person, I got the sense she was a good and perhaps somewhat spiritual woman. I proceeded to show her the MRI scan and discuss with her surgery and what it was I would likely be able to accomplish. I saw her on Monday and because of my schedule that week, I told her, it would be Thursday before I could operate. As I saw her over the next couple of days on my hospital rounds, her emotions ran the gamut from happy to fearful to tearful. On one occasion she told me, ‘I decided to call him Ernie!’ Initially I was puzzled and confused but then I got it. ‘Ah, the tumor’ I said, as she smiled and nodded affirmatively. I guess we all have different ways of coping with anxiety and stressful situations and for Samantha it was to refer to her tumor as a loveable character, one that couldn’t possibly hurt her.
Surgery on Thursday went well. I resected a majority of the tumor but I purposely left a small amount right up against the wall of the ventricle. The diagnosis was as I thought, a malignant astrocytoma, so I placed several chemotherapy wafers along the tumor that visibly remained. The following day I spoke with Samantha and told her how surgery went. She appeared a bit solemn and even though I tried to be encouraging she had hoped that I would have gotten the entire tumor out! When I asked if I could pray for her, I think it only served to remind her I had not cured her.
Within a day or two, however, she became upbeat again, determined to fight off this tumor as well as the idea that it could possibly grow back.
When I returned to see her that weekend, I knew her sense of humor returned when I asked her if the radiation oncologist had been by to see her. She said, ‘Yes he did and I asked him (with the treatment) if I was going to lose my mind…he said yes, so I guess I won’t ask any more questions!’ I smiled as she belied a smirk on her own face, nodded and told her I would see her later as I walked out of her room.
A few weeks later, I was walking into the clinic building, somewhat late, to see patients for the day. As I walked through the door with my eyes toward the elevator, I caught the figure of someone in my peripheral vision sitting down to the right of the door apparently waiting for her ride to pick her up. I stopped, turned and looked and to my pleasant surprise it was Samantha. She had just finished seeing Francy for her incision check.
I asked how she was doing and she said fine. She then told me, ‘Patrick Kelly (Professor of Neurosurgery at NYU) asked to see my films. Apparently, I’m related to him and didn’t even know it’. ‘Well he is nationally known as a brain tumor expert and it’s always great to get a second opinion’, I said. Samantha then replied, ‘Well I told them I have been very blessed to receive the care that I have’. I nodded and thanked her for saying so.
As I said goodbye and turned to walk towards the elevator, she spoke up, ‘You know, he’s not coming back’. For a split second I was confused once again and I’m sure my face appeared a bit bewildered, but then it hit me, ‘Ah, Ernie, right?’, I said. She smiled widely and said, ‘That’s right’.
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